Heroin is a drug made from the seed pod of the poppy plant. It can be found as a white or brown powder, or a black sticky substance known as black tar heroin. The powder form of heroin can be inhaled. Black tar heroin is typically diluted and injected.
Heroin affects the body by activating specific receptors within the central nervous system. These receptors release chemicals called neurotransmitters that control brain function, including pain and feelings of wellbeing. Heroin causes the brain to release dopamine, which causes feelings of pleasure. This results in the “high” associated with the drug.
A NIDA survey in 2012 reported that about 669,000 people in the US used heroin that year. Heroin use has increased in recent years, especially among people aged 18-25. The number of people using heroin for the first time each year doubled between 2006 and 2012.
Effects of Long-term Heroin Use
Heroin can have dangerous and lasting effects on the mind and body. Repeated and long-term heroin abuse damages major organs like the liver and kidneys, and it can cause permanent brain damage.
Short-term effects of heroin include:
- A rush of pleasurable sensation
- Reddening of the face
- Dry mouth
- A heavy feeling in the extremities
- Severe itching
- Clouded mental function
- Slowed heartbeat
- Slowed breathing
Repeated long-term use of heroin causes various changes to the structure of and chemicals in the brain. Many of these changes may be permanent. Heroin use quickly leads to tolerance; tolerance occurs when larger and larger doses of the drug are needed in order to achieve results that were previously felt after a smaller dose. Tolerance significantly increases the risk of overdose.
Physical dependence is also a frequent result of this drug, and once dependence is established, withdrawal will set in whenever use of the drug is stopped or lessened. In addition, heroin may deteriorate the white matter of the brain, which is responsible for decision-making and impulse-control abilities. These effects on the brain can make recovery from heroin abuse very difficult, especially for long-term users.
Long-term effects of heroin use include:
- Contraction of infectious diseases like HIV and hepatitis due to injection drug use
- Veins that have collapsed due to injecting the drug
- Infections at injection sites
- Heart lining and valve infections
- Liver disease
- Kidney disease
An overdose is one of the most serious and life-threatening risks associated with long-term heroin use. Large doses of heroin depress heart rate and breathing to such a degree that the brain experiences hypoxia – a lack of sufficient oxygen. This can lead to brain damage, coma, and death. Medical professionals can reverse the effects of an overdose using naloxone, a medication that blocks heroin from binding with receptors in the brain.
Many people who have been addicted to heroin for a long period of time suffer from mood disorders like depression, as well as other co-occurring mental health disorders, like antisocial personality disorder. Treatment should address all the medical and psychological conditions the individual is suffering from in order to effectively address the addiction.
Detox and Withdrawal
Long-term heroin use frequently leads to physical dependence, and a withdrawal syndrome will occur during detox. Withdrawal can be more serious for long-time users and for people who have undergone detox previously. Medical detox is always needed for heroin withdrawal to ensure safety and lessen the likelihood of relapse. Though opiate withdrawal is unpleasant, it is not usually life-threatening.
Heroin withdrawal symptoms include:
- Muscle aches
- Runny eyes or nose
- Trouble sleeping
- Abdominal cramping and nausea
- Intestinal issues
- Enlarged pupils
Symptoms typically appear about 12 hours after last heroin use and may last for several days.
Treating Heroin Abuse
Individuals who have suffered from heroin addiction and dependence for a long period of time have often attempted to quit using on multiple occasions. It can be discouraging to relapse into drug use, but it is often a normal part of the recovery process. Most people who eventually establish lasting sobriety have undergone multiple treatment attempts. Relapse isn’t a sign of failure; it’s sometimes simply part of the recovery process.
Effective treatment typically utilizes both behavioral interventions, like individual and group therapy, and the use of medication. You may need to try several different approaches before you find the one that is right for you.
Cognitive Behavioral Therapy (CBT) is one of the most frequently used therapy modalities and has been shown to be effective in treating addiction. CBT focuses on patterns of thought and behavior, and helps the individual in treatment recognize the patterns that are contributing to drug use. By anticipating future stressors and triggers, and preparing for them, CBT can help to prevent relapse and teach the individual different ways of thinking and behaving. The coping skills learned in therapy can be carried over into all areas of life and help to establish long-term recovery from heroin addiction and abuse.
Contingency Management is a treatment approach that offers rewards in exchange for certain behaviors, such as maintaining abstinence or engaging in treatment. By offering rewards when goals are met, Contingency Management creates a positive association with the treatment process, and can help the individual maintain abstinence through the most difficult phases of the treatment process. This approach can be highly effective, especially when combined with medication, as appropriate.
Motivational Enhancement Therapy can be a useful treatment approach when attempting to recover from long-term use of substances like heroin. This type of therapy is typically used during the beginning stages of treatment in order to enhance the motivation and resolve of the individual in recovery. Motivational Enhancement Therapy begins with an assessment and is followed by several sessions with a therapist to discuss any ambivalence about stopping heroin use. Once the individual is resolved to recover from heroin abuse, a treatment plan can be formed.
Medication is frequently used in the treatment of heroin addiction and abuse. The most common medications used for this purpose are methadone, buprenorphine, and naltrexone.
Methadone is one of the most frequently used medications in heroin addiction treatment. It is an opioid agonist, meaning it mimics many of the effects of illicit opioid drugs like heroin. By having similar effects on the brain, it eases withdrawal symptoms during detox, and it can be used as a maintenance medication in order to establish long-term sobriety. To undergo methadone treatment, an individual needs to be enrolled at a licensed methadone clinic. The medication must be administered within the clinic, and dosages are carefully controlled in order to avoid abuse.
Buprenorphine is similar to methadone in that it also mimics some of the effects of heroin. This medication is a partial opioid agonist, meaning it eases withdrawal symptoms and cravings without causing the euphoria or “high” of heroin. This limits abuse potential and lowers risk of overdose. Buprenorphine is often combined with naloxone, which blocks opioid receptors. The addition of naloxone discourages individuals from abusing buprenorphine. Unlike methadone, buprenorphine can be administered in an office-based setting by licensed physicians. The medication may be provided onsite, or it may be offered via prescription to take at home.
Naltrexone is an opioid antagonist. This type of medication blocks opioids from binding with receptors within the central nervous system, which prevents heroin from having any effect. Rather than treating withdrawal symptoms like methadone and buprenorphine do, naltrexone’s main function is to discourage relapse. This drug has no abuse potential and is not addictive. By helping to establish sobriety, naltrexone can encourage normal brain function and assist in the recovery process. Treatment with naltrexone is generally most successful among people who are highly motivated to quit heroin use, since noncompliance is a common problem with this medication.
Since abuse of certain heroin treatment medications, like buprenorphine and methadone, does occur, medical supervision is essential. For those addicted to heroin, long-term inpatient care is often the best option to prevent abuse of treatment medications and ensure long-term recovery.